Rétablissement subjectif dans la schizophrénie : nouveauté ou renouveau ?

International audienceObjectivesThis study wants to explore the theories surrounding recovery from psychosis in an historical perspective and to focus on the impact of subjectivity in the recovering process, as much as in the definition of recovery.Material and methodsA review of the literature was done according to major historic description of madness, dementia praecox and schizophrenia during last century. Factors of changes in theories were investigate from French and English-speaking literature. Theories have been discussed to bring up their limits in understanding the process of recovering.ResultsRecovering from psychosis is still an ongoing topic. Although the results of first alienists tend to prove the possibility of remission from madness, since the description of dementia praecox by Kraepelin, and despite the original definition of schizophrenia by Bleuler, most of psychiatrists liken psychosis to a bad prognostic. Three major studies were conducted in twentieth century – those of Manfred Bleuler, of Ciompi and Müller, and of Huber and Gross – that showed statistic amelioration in schizophrenia when long-term course is monitored. More recent studies, as the WHO collaborative project on schizophrenia published in 2007 lead to same conclusions. Notwithstanding those academic results, it seems that first person accounts couple with patients and family association's lobbying were necessary to conduct practitioners to take into account the evidence that most of them remit from psychosis. Having assumed that remission from a mental disease does require specific definition, most studies opted for the term of recovery which seems more appropriate to describe the specific, singular journey as a process and not only as a target. Biopsychosocial approach in medical sciences do a lot for this mutation, but still does remain insufficient. Many goals have been taken into account to define what would be a good recovery which involve personal motivation. In doing so, those approach does not consider the psyche distinct from reasoning, and do not assume the unconscious although it intend to study increasingly subjectivity. Because recovery as defined by academic is inevitably insufficient to tell the diversity of singular solutions to deal with psychotic symptoms, some studies have taken into account subjective factors not only for prediction but also for description of what can be considered by former patients as recovering. Training programs have been elaborate to help people to achieve seven goals. These programs, despite growing interest, do not seem to show better results than older one.ConclusionTaking into account subjective factors is a need when considering recovering from schizophrenia. Structured educational programs do remain dependent of value-based judgment, although patients’ definitions of having recover does not always coincide with the expected steps. A model is always insufficient when talking about personal journey through illness. It may be interesting to abandon the theory based on the existence of cognitive disability as central symptom, and to consider qualitative studies.Malgré les résultats des premiers aliénistes démontrant les potentialités de guérison de la maladie mentale, la description de la démence précoce par Kraepelin aura pour conséquence d’associer la psychose à une évolution déficitaire. De grandes études catamnestiques viendront contredire cette conception, mais c’est surtout aux associations d’usagers que la psychiatrie devra sa mutation dans le domaine. Si les perspectives de rétablissement sont maintenant assez bien diffusées en ce qui concerne la schizophrénie, les impasses qu’elles rencontrent de même que l’évolution des disciplines médicales s’occupant des maladies au long cours orientent actuellement la recherche vers une prise en compte de facteurs subjectifs d’évolution, rompant ainsi avec une logique déficitaire de la psychose